ECDC warns North Macedonia fire could lead to spread of carbapenem-resistant bacteria

News brief

European health officials are warning hospitals across Europe to take precautions in treating patients with burn injuries from a recent nightclub fire in North Macedonia.

The European Centre for Disease Prevention and Control (ECDC) said in a news release that burn wounds are often colonized by gram-negative bacteria—such as Pseudomonas aeruginosa, Acinetobacter spp, and Enterobacterales—that are resistant to multiple antibiotics and can spread easily in hospital settings. The ECDC also noted that surveillance data from North Macedonia in 2023 indicated a high incidence of carbapenem-resistant (CR) bacteria, which are frequently multidrug-resistant and have limited treatment options.

Hospitals urged to take steps

ECDC officials said many burn victims from the fire, which killed 59 people and injured dozens, have been transferred to hospitals in neighboring countries and other European Union member states. They urged healthcare systems in those countries to take proper precautions to protect against the spread of CR bacteria.

"ECDC recommends hospitals receiving patients from North Macedonia implement precautions to prevent the potential spread of CR bacteria," the agency said. "These include isolating patients in single rooms immediately upon admission or grouping such patients, screening for multidrug-resistant bacteria including CR bacteria, ensuring strict hand hygiene and environmental cleaning, and using antibiotics judiciously."

The ECDC also urged countries to share any information on CR bacteria found in transferred patients.

Antiviral drug ensitrelvir shows promise in preventing household COVID spread

News brief

Mary Van Beusekom, MS

Man taking an antiviral — *Igor Vershinsky / iStock*

People who started taking the antiviral drug ensitrelvir within 72 hours after a household member tested positive for COVID-19 were significantly less likely to be infected, according to results from an international phase 3 clinical trial presented last week at the Conference on Retroviruses and Opportunistic Infections in San Francisco.

Made by Japanese pharmaceutical firm Shionogi, ensitrelvir is approved in Japan for the treatment of mild to moderate COVID-19.

Researchers conducted the double-blind Stopping COVID-19 pRogression with early Protease InhibitOr treatment—Post-Exposure Prophylaxis (SCORPIO-PEP) trial evaluating a 5-day course of oral ensitrelvir for post-exposure infection prevention from June 2023 to September 2024. Among all participants, 37% had at least one risk factor for serious COVID-19 complications.

67% risk reduction

Of the 2,387 trial participants aged 12 years and older in countries that included the United States, 9.0% of placebo recipients contracted COVID-19 from a household member, compared with 2.9% of ensitrelvir recipients, for a 67% reduction in the risk of symptomatic infection, and the two groups had a similar risk of adverse events.

In addition to vaccination, post-exposure prophylaxis with timely use of an oral antiviral would be a valuable way to help prevent COVID-19 illness in people who have been exposed, especially people at high risk for severe disease.

Frederick Hayden, MD

"In addition to vaccination, post-exposure prophylaxis with timely use of an oral antiviral would be a valuable way to help prevent COVID-19 illness in people who have been exposed, especially people at high risk for severe disease," Frederick Hayden, MD, a University of Virginia School of Medicine professor emeritus who helped design the trial and presented the findings, said in a university news release.

"This is the first clinical trial of an oral antiviral drug to show significant protection against COVID-19 [infection]," he added. "If approved by the [US] Food and Drug Administration for this purpose, it would be an important addition to current preventive strategies."

Florida health system reports increase in Candida auris infections

News brief

Chris Dall, MA

A retrospective study conducted at a large health system in Florida found that the volume and complexity of infections caused by Candida auris have rapidly increased over the last few years, researchers reported this week in the American Journal of Infection Control.

In the study, researchers at Jackson Health System in Miami, which reported its first C auris case in 2019, identified 327 clinical cultures of the multidrug-resistant fungus in 231 patients from April 2019 through December 2023. The number of C auris–positive clinical cultures increased each year, rising from 5 in 2019 to 115 in 2023. Expressed as rates per 100,000 patients, this represented an increase from 4.0 positive cultures in 2019 to 28.0 in 2023—or a sevenfold increase. Hospital-onset and community-onset infections accounted 79.5% and 21.5% of cases, respectively.

Blood cultures positive for C auris increased from 2019 through 2021 and remained the predominant source throughout the study period, but the proportion of C auris–positive blood cultures declined and stabilized in 2022 and 2023. At the same time, the health system saw a considerable increase in specimens from soft-tissue and bone infections in 2022 and 2023.

Phylogenetic analysis of 13 samples showed that all isolates belonged to clade 3, the South African clade. Antifungal susceptibility testing showed all isolates were resistant to fluconazole and susceptible to micafungin and amphotericin B.

Increase consistent with national trends

The study authors note that the increase in the volume of C auris–positive clinical cultures is consistent with US national trends. According to the Centers for Disease Control and Prevention, the annual number of clinical C auris cases in the United States has risen from 51 in 2016 to 4,514 in 2024.

The authors say the increase in bone and soft-tissue infections is a particular concern because the management of such infections often necessitates wound care, which can in turn increase the burden of C auris environmental contamination in the hospital and put others at risk.

"Containment and mitigation strategies require rapid identification of patients colonized with this organism and, thus, call for providing adequate resources to infection prevention programs and clinical microbiology laboratories," they wrote.